Preoperative Optimization

Patients with hyperaldosteronism should have adequate control of blood pressure and correction of hypokalemia and other electrolyte abnormalities. Alpha-blockers, namely phe-noxybenzamine, and beta-blockers are administered in patients with pheochromocytomas to control reflex tachycardia when needed. The authors initiate administering these drugs three to four weeks prior to surgery and assess their efficiency by monitoring the improvement of symptoms, stabilization of blood pressure, and the presence of mild orthostatic hypotension. Following this concept, the mortality of patients with pheochromocytoma has declined to 1% (31). A different approach to manage hypertension using calcium channel blockers started as late as 24 hours prior to surgery has shown good results (32).

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